A National Insurer Goes Local: Emerging Strategies for Integrating Health and Housing

Scally CP, Waxman E, Gourevitch R
Publication Year: 2017
Patient Need Addressed: Behavioral health, Care Coordination/Management, Homelessness/housing
Population Focus: Medicaid beneficiaries
Intervention Type: Partnership, Staff design and care management
Type of Literature: Grey

UnitedHealthcare provides health insurance benefits to more than 40 million people across the country. In the past decade, it has addressed housing as a social determinant of health at the national level through policy leadership and financial investments, and at the state level working with local communities to connect Medicaid participants to stable housing. Through this work, UnitedHealthcare has overcome a myriad of challenges associated with siloed health and housing fields at all levels of policy and implementation. This case study explores how this national health payer has integrated the housing needs of underserved populations into its strategic priorities for investment and programming. This case study is part of a larger report on Emerging Strategies for Integrating Health and Housing

Insights Results

Overview of model/article

  • United HealthCare’s (UHC) efforts to address housing instability predate the ACA, but efforts increased after many childless single adults became UHC Medicaid members following the ACA’s Medicaid expansion
  • UHC includes the treasury, product, and policy team to drive housing initiatives. Housing initiatives were financed through Low-Income Housing Tax Credits (LIHCT), which is a 15-year federal tax credit claimed over 10 years that finances low-income housing. However, the demand for LIHCT is high and the tax credit is limited to housing and cannot be used to more broadly address SDOH. Despite these challenges, the LIHCT is foundational to UHC’s approach, having invested more than $350 million into communities through LIHTC
  • UHC is pursuing other investments, such as Pay for Success opportunities, which tie payment for services (e.g., supportive housing for individuals coming out of jail) to specific evidence-based outcome goals. UHC also conducts systematic reviews of each state’s Medicaid programs to assess whether there are significant provisions that could enable housing work, such as behavioral health carve-outs, coverage of supportive services (e.g., care coordination, case management), or coverage for housing or tenancy supports. In Hawaii, UHC was awarded the ACH grant from CMS to launch a project in Honolulu that examines cost savings associated with better coordination of social services
  • Partnerships are essential to UHC’s participation. It works closely with local and national housing leaders (e.g., developers, homeless service providers, FQHCs, and Medicaid departments). Because UHC does not have housing expertise, it leverages “housing navigators” to act as liaisons to local entities, working as brokers in regions where UHC wants to build strategic partnerships. Early engagements taught UHC important lessons. For example, many housing organizations are ill-equipped to manage UHC’s burdensome data requirements. Consequently, UHC developed a more streamlined approach that maintained rigorous state/federal requirements
  • Prior to investing in initiatives, UHC models potential impacts and outcomes, map SES characteristics to identify appropriate interventions, and pinpoint high rates of utilization that might reduce costs. Using claims, it has shown that shortly after a pilot targeting the chronically homeless, there was an initial spike in utilization followed by a longer-term decrease

    Key takeaways/implications

    • Key successes include developing partnerships with both local and federal stakeholders. UHC’s comprehensive organizational structure also allowed it to tackle housing internally from a variety of angles
    • Challenges include understanding the housing landscape as well as tracking and evaluating some interventions